Philippine Action Plan to Combat Antimicrobial Resistance: One Health Approach

SECTION 1. Creation and Composition. The Inter-Agency Committee (hereinafter referred to as the Committee) is hereby created, to be composed of representatives from the following: Co-Chairs: Department of Health (DOH) Department of Agriculture (DA) Members: Department of Science and Technology (DOST) Department of the Interior and Local Government (DILG) Department of Trade and Industry (DTI) DOH shall provide secretariat support to the Committee. The Committee may call upon any department, bureau, office, agency, or instrumentality of the government, and request the local government units and private sector for assistance as the circumstances and exigencies may require. Philippine Action Plan to Combat AMR: One Health Approach 19 The duly authorized representatives of the member-agencies of the Committee shall have a rank not lower than Assistant Secretary.

SECTION 2. Functions. The Committee shall have the following functions: a) Formulate, develop and implement and oversee the national plan for the prevention and control of AMR; b) Collaborate and coordinate with other agencies of the Executive branch and private and non-government sectors; c) Promulgate guidelines, rules and regulations, as well as possible penalties and sanctions for violations in accordance with existing laws, as may be necessary, related, incidental, or consistent with the purpose, intent, and objective of this Order; d) Submit to the office of the President regular status reports on the implementation of the national plan; and e) Perform such other functions and activities as may be necessary to carry out the provisions of this Order, or as the President may direct.

SECTION 3. Development of the National Plan. A comprehensive and sustainable plan to combat AMR in the country shall be developed which will include, but not be limited to the following: a) Establishment of short and long term programs to address the different aspects of response to AMR, including advocacy, management of AMR and the regulation of antimicrobial use; b) Strengthening the surveillance system and laboratory detection capacity for AMR and its use in humans and animals; c) Ensuring accessibility, affordability, availability, and quality of antimicrobial drugs for humans, as well as their rational use in humans, food producing animals and aquaculture; d) Guaranteeing that antimicrobial agents are prescribed, dispensed, promoted, advertised and used according to the licensed indication; e) Development of relevant and utilizable essential medicines list for human and veterinary use; f) Institutionalization of infection prevention and control in healthcare and veterinary facilities and the community through training and education; and g) Conduct of research towards the development of new antimicrobials and innovative technologies to improve diagnosis and treatment

SECTION 4. Funding. The member-agencies of the Committee are authorized to charge against their current appropriations such amounts as may be necessary for the implementation of this Order, subject to the budgetary, accounting and auditing rules and regulations. Subsequent funding requirements shall be incorporated in the annual budget proposals of the respective member-agencies through the General Appropriations Act (GAA). Additional funds and possible fund sources as may be necessary for the implementation of this Order shall be identified and provided by the DBM.

Section 5. Separability Clause. Should any provision of this Order be declared invalid or unconstitutional, the other provisions unaffected thereby shall remain valid and subsisting.

Section 6. Repealing Clause. All orders, proclamations, rules, regulations or parts thereof, which are inconsistent with any of the provisions of this Order are hereby repealed or modified accordingly.

Section 7. Effectivity. This Order shall take effect immediately. th DONE, in the City of Manila, this 10 day of April, in the year of Our Lord, Two Thousand and Fourteen. By the President: Philippine Action Plan to Combat AMR: One Health Approach 20 PAQUITO N. OCHOA, JR. Executive Secretary As the lead national agencies, the DOH and DA are delegated as Co-Chairs of the ICAMR. The DOH primarily functions to provide technical secretariat support to the committee. Together with the DA, they are both responsible in establishing policies that address AMR, and to ensure that antimicrobials of quality are accessible and affordable for Filipinos. They are also tasked to regulate these agents in the market, and to create essential medicines lists, treatment guidelines, systems, platforms, risk communication plans and IEC materials for both human and veterinary use. With regards to monitoring and evaluation functions, these two agencies are also mandated to establish AMR and antimicrobial use surveillance programs. The DOST, DILG and the DTI are concurrently mandated to participate as members of the ICAMR. The main participation of the DTI is in the strengthening of the surveillance systems and laboratory detection capacity for AMR and its use in humans and animals by ensuring that facilities conform to international standards. The DOST functions to take lead in the prioritization of AMR in health agendas and researches aimed to develop new antimicrobials and innovative technologies to improve diagnosis and treatment. On the other hand, the DILG is responsible for the coordination and implementation of AMR policies to the local governments to ensure that strategies to address AMR reach communities and household level. Philippine Action Plan to Combat AMR: One Health Approach 21 CHAPTER 4: The Philippine Action Plan to Combat AMR: One Health Approach The complex issue on AMR warrants a multi-sectoral intervention not only to contain the increasing drug resistance of bacterial pathogens as provided by the ARSP data, but more importantly, to assure the safety of both humans and animals in the country. The “Philippine Action Plan to Combat AMR” serves as the country roadmap towards containing, controlling and preventing AMR which provides an intervention strategy in order to facilitate the mechanisms of combating the growing problem of AMR as one nation through political commitment and leadership, institutionalizing integrated surveillance systems, regulating access to quality antimicrobials, rational use of antimicrobials, establishing measures to prevent and control further spread of AMR, and strengthening research and development initiatives. This comprehensive plan emphasizes the “One Health Approach” as it recognizes that the causation of AMR is inter-related and inter-sectoral thereby requiring collaborative multidisciplinary work at local, national, and global levels to attain optimal health for humans, animals and the environment. Vision A nation protected against the threats of antimicrobial resistance Mission To implement an integrated, comprehensive and sustainable national program to combat AMR geared towards safeguarding human and animal health while preventing interference in the agricultural, food, trade, communication and environmental sectors Philippine Targets to Combat Antimicrobial Resistance By 2020, the Philippines will: 1. Reduce by 30% carbapenem-resistant Enterobacteriaceae (E. coli and Klebsiella) infections acquired during hospitalization 2. Maintain the prevalence of ceftriaxone-resistant Neisseria gonorrhoeae to 0% 3. Reduce by at least 30% overall methicillin resistance in Staphylococcus aureus bloodstream infections compared to rates in 2014 4. Reduce by 30% multidrug-resistant Pseudomonas spp infections acquired during hospitalization compared to estimates in 2014 5. Reduce by 25% ciprofloxacin-resistant non-typhoidal salmonella infections compared to 2014 Philippine Action Plan to Combat AMR: One Health Approach 22 Key Strategy 01: Commit to a comprehensive, financed national plan with accountability and civic society engagement Human Health The critical role of the Philippine government is to lead and consolidate the fragmented efforts by individual programs or institutions through the creation of a National Action Plan and by providing policies and a legal framework towards the main goal of combating AMR in the country. The recognition of this problem is not only expected from the different government departments, but also from the private and non-governmental sectors. A commitment from all these stakeholders would allow for various targets to be reached simultaneously, and for more resources to be generated. In order for this to be possible, an effective assessment of costs and potential savings from the reduction of AMR must also be in place. Moreover, the government needs to collaborate with the civil societies to raise awareness and disseminate information about the rising AMR issue to the public properly. Responsible Objectives Activities Timeline Measurement Budget (PhP) Agency To forge a joint Convening of 2014 – Q3 National Action DOH (PD) 250,000 action plan and ICAMR to Plan on AMR agreement consolidate the among national AMR plans from agencies concerned agencies Briefing of DOH 2015 Briefer and DOH (PD), Execom presentation ICAMR members of concerned agencies on AMU and AMR issues To generate Submission of 2015 onwards Approved ICAMR None resources and project project; grant; enhance internal proposals to funding and external international agreement networking organizations or relevant funding agencies Lobbying for 2014-2015 Approved GAA; ICAMR member budget (GAA, MOA/ MOU agencies Sin Tax, International Partners, WHO) Animal Health Following the One Health Strategy, the animal sector, likewise, must play a role in the judicious use of antimicrobials. The transmission of AMR in both domestic and wild animals across different environments and geographic distances warrants a continuous collaboration with the Department of Agriculture. The ecology of AMR has long been present in both the soil and water microbiomes, such that streamlining efforts with other partner-agencies not only enables increased mobilization of resources, but also a better foundation to address knowledge gaps about AMR, especially in the veterinary health sector. Philippine Action Plan to Combat AMR: One Health Approach 23 Responsible Objectives Activities Timeline Measurement Budget (PhP) Agency To forge a joint Information 2014 – Q2 DA DA (OSEC) 150,000.00 action plan and dissemination Memorandum agreement on A.O. No. 42 among national among agencies concerned DA agencies Identification of 2014-Q3 Endorsement DA (OSEC) official and Letter from DA- alternate OSEC to DOH representatives for the ICAMR Approval of 2014-Q3 Approved DA (ASEC on Special Order Special Order; Livestock; NMIS for the creation Endorsement of as Secretariat) of DA TWG to AMR plan consolidate the AMR plan To generate Submission of 2015-onwards Approved ICAMR None resources and project project; grant; enhance proposals to funding internal and international agreement external organizations/rel networking evant funding agencies Lobbying for 2014-2015 Approved GAA; ICAMR member budget (GAA, MOA/ MOU agencies Sin Tax, International Partners, WHO) Budget proposal 2015 onwards Approval of DA member for continuous GAA for DA agencies appropriations in GAA Submission of 2015 Approved DA member project project; grant; agencies proposals to funding international agreement organizations/rel evant funding agencies Philippine Action Plan to Combat AMR: One Health Approach 24 Key Strategy 02:Strengthen surveillance and laboratory capacity Human Health Establishing surveillance systems on monitoring resistant pathogens as well as the consumption of antimicrobials plays a very significant role in developing evidence-based policies to control/ limit overuse of antimicrobials which was identified as a major contributory factor to the emergence of AMR, in designing effective guidelines for feedback and control mechanisms on addressing AMR outbreaks in the country. Empowering and increasing the skills set of health professionals and laboratories that take part in the process of surveillance enable reliable and robust diagnostic testing and proper data to be reported. With proper information and sharing of surveillance studies across borders, targeted approaches and treatment strategies may be developed to limit the spread and emergence of pathogens with AMR. Responsible Objectives Activities Timeline Measurement Budget (PhP) Agency To improve the Assessment and 2015 A design for the DOH (FDA) and None surveillance inventory of upgrading of DTI capacity of resources for laboratories for health monitoring, AMR and drug personnel, surveillance and residue testing hospitals and testing and manual for laboratories (Including Price biosafety and Reference of biosecurity Laboratory harmonized to supplies and DOH guidelines equipment) Foreign and 2015 Technical DOH and DTI 50,000,000 local training of personnel abled technical and qualified to personnel on handle monitoring, surveillance, surveillance and monitoring and testing methods testing of and the samples for operation of AMR; A manual laboratories, of policies and including procedures for compliance to the design/ accreditation implementation/ standards (PNS upgrading of ISO/IEC 17025, surveillance and PNS ISO 15189, monitoring PNS ISO/IEC programs 17020, Codex) Management of 2015-2016 Government DOH (HFDB) 800,000 the National and private The role of Health laboratories HFDBis to Laboratory licensed by advocate for Referral DOH (starting and help Network (DOH with levels 2 and establish A.O. No. 2012- 3 hospitals) Regional 0021) apply and Laboratory qualify for Networks/Counc membership to ils (A.O. No. the National 2014-0006). It is Health the Reg. Lab. Laboratory Network Council Philippine Action Plan to Combat AMR: One Health Approach 25 Network through which sets the the Regional priority goals Laboratory and activities in Network their region with Councils. the technical Membership at assistance of the moment the NHLN. voluntary. Strengthen the 2015 A system of DOH (HFDB, 5,000,000 implementation notification and HFSRB and EB) of Hospital- alert for HAI thru Acquired NEC; Protocols Infection (HAI) for centralized surveillance in reporting and hospitals thru feedback; conduct of Training trainings of ICC manuals for chairs and reporting nurses system; Protocols for centralized reporting and feedback; Training manuals for reporting system Expansion of 2016 Number of DOH (RITM) 30,000,000 ARSP to DOH- sentinel sites retained hospitals To develop Development of 2015 Annual AMU DOH (PD) 7,000,000 programs and a surveillance report systems for system for surveillance and antimicrobial monitoring of use (AMU) AMR Development of 2015-2016 Annual DOH (PD, an integrated integrated report RITM, EB, system for AMR, on AMU, AMR HFSRB and AMU and HAI and HAI HFDB) Development of 2015-2016 AMR Dashboard DOH (RITM, an IT platform to PD, and EB) communicate data on AMR to stakeholders Philippine Action Plan to Combat AMR: One Health Approach 26 Animal Health The impact of AMR in the agricultural sector is not yet well comprehended, and this substantiates the need for an improvement in the current state and evolution of AMR trends in animal health. It is known that the judicious use of antimicrobials in food-producing animals is a critical step in lessening the AMR patterns seen in human medicine, so it is essential for an effective monitoring system to be in place from the point of slaughter to processing of animals, as well as the implementation of surveillance systems focusing on AMR mitigation strategies in animals. Responsible Objectives Activities Timeline Measurement Budget (PhP) Agency To improve the Identification of 2015 onwards Designated DA (BAI) 60,000,000.00 capacities of DA national and AMR health regional laboratories personnel, laboratories that hospitals and for AMR laboratories surveillance and monitoring Assessment and 2015 A design for the DA (BAI) and inventory of upgrading of DTI resources for AMR monitoring, laboratories surveillance and testing Hiring of 2015 Approved Job DA additional Order; Contract personnel for hired JO Foreign and 2015 Technical DA and DTI local training of personnel abled technical and qualified to personnel on handle monitoring, surveillance, surveillance and monitoring and testing methods testing of and the samples for operation of AMR laboratories including compliance to accreditation standards (PNS ISO/IEC 17025, PNS ISO 15189, PNS ISO/IEC 17020, Codex) Improvement of 2015-2016 Upgraded DA facilities and laboratories with purchase of required necessary equipment equipment and laboratory supplies, glassware, culture media, reagents or test kits, etc. for AMR laboratories Philippine Action Plan to Combat AMR: One Health Approach 27 To develop Development of 2015 onwards Manual of DA (BAI and 5,000,000.00 programs and surveillance and procedures and BFAR) systems for monitoring harmonized surveillance and system for AMR standards; monitoring of and AMU in AMR/AMU AMR food-producing reports in animal animals species; Protocols for reporting system and feedback system Data 2015 onwards Data collected / DA (BAI and 25,000,000.00 collection/sampli samples tested / BFAR) ng/testing/ analyzed and analysis of Drug results Residue in reviewed. animals (focus on AMR) - for A report on the clarification of occurrence of DA AMR in animal species and on production practices relevant to the emergence of AMR Sampling and 2015 onwards Reports on AMR DA (BAI and testing analysis in animal BFAR) for antibiotic species susceptibility testing based on internationally accepted standards Monitoring of 2015 onwards Regular DA (BAI and AMR and AMU dissemination of BFAR) trends in food- reports on AMR producing in animal animals species Philippine Action Plan to Combat AMR: One Health Approach 28 Key Strategy 03:Ensure uninterrupted access to essential medicines of assured quality Human Health Taking substandard or counterfeit antimicrobials containing less than the specified amount of the active ingredient, or consuming suboptimal dosage due to lack of supply or limited accessibility to antimicrobials contributes to the overall AMR problem because infections persist and resistant microbes are able to grow and survive the treatment. Ensuring sustainable access to quality essential antimicrobials is therefore, integral in successfully hampering the development of AMR. This is made possible primarily by strengthening the regulatory measures, tools and activities of the national drug regulatory agency in ensuring the safety, efficacy and quality of medicines from market authorization to post-marketing surveillance. Efforts must also focus on sustaining an efficient supply chain system towards ensuring the availability or accessibility of quality medicines to all patients at all times, with emphasis on completing the course of treatment. Responsible Objectives Activities Timeline Measurement Budget (PhP) Agency To improve the Monitoring the 2015 onwards PMS report on DOH (FDA) None registration, quality of the quality of marketing registered registered authorization antimicrobials in antimicrobials and post- the market and the marketing presence of surveillance of unregistered antimicrobials antimicrobials Process 2014 onwards Protocols for DOH (FDA) and 8,000,000.00 streamlining of facilitated DA (BAI, BFAR review and processes of and OPP) release of review and marketing marketing authorization of authorization of new antibiotics new antibiotics that address available in priority websites; infectious issuance of diseases in the certificate of country product registration, license to operate for antimicrobials and importation clearance Forging an 2015 Approved joint DOH (FDA) and None agreement on AO including DA (BFAR) regulatory sanctions on control over products with drugs used in positive aquaculture antibiotic residues Rationalization 2015 Agreed policy DOH (FDA) and and between DA and DA (BFAR) harmonization of DOH; regulatory Enactment of control over the Animal Industry manufacture and Veterinary and use of Services Act antibiotics in (AIVSA) animals Philippine Action Plan to Combat AMR: One Health Approach 29 To ensure Forging of 2015-2016 MOA/MOU DOH (FDA and None access to partnership with PD) essential healthcare medicines professionals, organization, and consumer groups Review of 2015-2016 Reports; DOH (FDA and issuances Minutes of the PD) related to Meeting access to antimicrobials, especially in the distribution and sale in drug outlets Strict 2014 onwards Monitoring DOH (FDA) enforcement of reports regulations on antibiotic prescription, dispensing and use Mainstreaming 2015 PHIC DOH (FDA, of complete reimbursement PHIC and PD) treatment package regimen thru reimbursement schemes Animal Health Philippine Action Plan to Combat AMR: One Health Approach 30 The local demand for safe food products such as milk, meat, fish and eggs, is currently dependent on antimicrobial agents, such that micro-organisms are not acquired by people, who consume them. Regulatory agencies, therefore, must be able to implement quality control mechanisms, and have them in place so that AMR is not worsened. Responsible Objectives Activities Timeline Measurement Budget (PhP) Agency To improve the Process streamlining of 2014 Protocols for DOH (FDA) and 8,000,000.00 registration, review and release of onwards facilitated DA (BAI, BFAR marketing marketing authorization processes of and OPP) authorization of new antibiotics that review and and post- address priority marketing marketing infectious diseases in authorization of surveillance of the country new antibiotics antimicrobials available in websites; issuance of certificate of product registration, license to operate for antimicrobials and importation clearance Development of a 2015 Database DA (BAI and 2,000,000.00 database of registered onwards available in BFAR) and DOH antimicrobials, websites (FDA) including quantitative production and importation Quality monitoring of 2015 Quality Reports DA (BAI and veterinary drugs onwards BFAR) and DOH (FDA) Monitoring of use of 2015 Monitoring DA (BAI and unregistered onwards reports on use BFAR) and DOH antimicrobials in of unregistered (FDA) animals antimicrobials DA (BAI and BFAR) and DOH (FDA) Forging an agreement 2015 Approved joint DOH (FDA) and None on regulatory control AO including DA (BFAR) over drugs used in sanctions on aquaculture products with positive antibiotic residues Rationalization and 2015 Agreed policy DOH (FDA) and harmonization of between DA and DA (BFAR) regulatory control over DOH; the manufacture and Enactment of use of antibiotics in Animal Industry animals. and Veterinary Services Act (AIVSA) To ensure Forging of partnership 2015- MOA/MOU DA (BAI and None access to with healthcare 2016 BFAR) essential professionals, Philippine Action Plan to Combat AMR: One Health Approach 31 medicines organization, and consumer groups Review of issuances 2015- Reports; DA (BAI and related to access to 2016 Minutes of the BFAR) antimicrobials, Meeting especially in the distribution and sale in drug outlets Strict enforcement of 2015 Monitoring DA (BAI and regulations on onwards reports BFAR) antibiotic prescription, dispensing and use Key Strategy 04:Regulate and promote the rational use of medicines in the human and animal health sectors Human Health While AMR is a natural phenomenon in microbes that happen as an adaptation to external threats, humans have definitely hastened it. The WHO has identified irrational use or misuse of antimicrobial medicines as a major driver of AMR, which is associated with a variety of management and healthcare provider concerns. Misinformation, lack of information dissemination and existence of proper guidelines and training of health care providers all lead to improper dispensing, prescription and treatment. Advertisements and other tools being used to promote drugs merely for profit without taking into considering its ill-side effects further lead to worsening AMR consequences. Community purchases are often times made without prescriptions. There is significant relationship between the unit cost of drugs and patient compliance, proving that the socioeconomic status of the patient remains to be a cause of therapy problem. Cognizant of the above pervasive inappropriate and irresponsible practices contributing to the over-all burden of AMR, it is therefore imperative that concerted actions must be focused on institutionalizing rational use of antimicrobials among the healthcare providers and the patients. Responsible Objectives Activities Timeline Measurement Budget (PhP) Agency To foster an Strict regulation 2015 onwards Public DOH (FDA and 16,500,000.00 enabling of promotion advisories, PD) and DA environment for and marketing advertisements, (BAI) the rational use of antimicrobials policies and of medicines for human and standards veterinary use Institutionalizatio 2015 Training DOH (FDA and n of Philippine manuals and PD) Practice conduct of Standards for trainings for Pharmacists pharmacists on (PhilPSP) in rational relation to dispensing of Rational antimicrobials Dispensing of Antimicrobials Development of 2015-2016 National DOH (PD) National Antibiotic Antibiotic Guidelines Guidelines for disseminated to hospitals and health facilities primary health Philippine Action Plan to Combat AMR: One Health Approach 32 care facilities Development of 2015-2016 Development of DOH (PD, Antimicrobial policy for AMS DPCB and Stewardship implementation HFDB) Program (AMS) in hospitals; in hospitals Training materials for implementing ASP; Conduct of pilot implementation in 8 hospitals Inclusion of 2015-2016 RUM modules ICAMR RUM principles integrated in in health primary, education secondary and components of tertiary school curricula education and adult education programs and in the Continuing Professional Education (CPE) of health professionals Development/up 2015 National DOH (DPCB dating treatment Treatment and PD) guidelines for Guidelines specific developed diseases Training/Dissem 2015 Number of DOH (DPCB ination of the trained and PD) National personnel Treatment Guidelines Conduct of 2015 onwards Minutes of DA (BAI,BFAR Incorporated in coordination Meeting; and OPP), DOH the Key Strategy meetings and agreements and DILG 04 of Animal workshops for Health implementation of policies with local governments Animal Health The existing regulatory frameworks concerning the use of antimicrobials in the animals are lacking and not properly enforced. These systems need to be strengthened to potentially create an impact on the resistance levels in the country. Immense quantities of antibiotics are consistently used for growth promotion and disease prevention in animals, and have significantly higher values compared to usage of humans for various illnesses. It is necessary to have a rational use of antimicrobials in place so that wastes containing drug residues from large- Philippine Action Plan to Combat AMR: One Health Approach 33 scale animal farms and aquaculture are minimized. These are potential sources for AMR genes and antibiotic pollution in the environment, and are considered to be major factors in the heightened AMR found in the animal sector. Responsible Objectives Activities Timeline Measurement Budget (PhP) Agency To fosteran Review of existing 2015 onwards Status report on DA (BAI, BFAR 5,000,000.00 enabling regulations and the and OPP) environment regulatory controls strengthening of for the for registration, various rational use of advertising, regulations for medicines importation and veterinary drugs; end use compendium of relevant laws, AOs and circulars Continuous 2015 onwards Publication of DA (BAI) monitoring of banned drugs; banned status reports antimicrobials Improved 2015 onwards Compliance DA (BAI, BFAR implementation of report and OPP) Policy on Prescribing and Dispensing of Veterinary Drugs (VDO) Conduct of 2015 onwards Minutes of DA and DOH dialogue/meeting Meeting; (FDA) with clients, agreements stakeholders, industry Training on 2015 onwards Number of DA and DOH international trained (FDA) standards of personnel consumer products Creation of a 2015 onwards Issued Special DA and DOH “Veterinary Order (FDA) Formulary Executive Council” Institutionalization 2015 Training DA of Philippine manuals and Practice conduct of Standards for trainings for Veterinarians in pharmacists on relation to Rational rational Dispensing of dispensing of Antimicrobials antimicrobials Development of 2015-2016 National DA National Antibiotic Antibiotic Guidelines for Guidelines animal health disseminated to veterinarians Development of 2015 onwards Training DA antimicrobial materials for stewardship implementing program (ASP) in ASP Philippine Action Plan to Combat AMR: One Health Approach 34 animal husbandry Conduct of 2015 onwards Minutes of DA (BAI,BFAR coordination Meeting; and OPP), DOH meetings and agreements and DILG workshops for implementation of policies with local governments Key Strategy 05:Enhance infection prevention and control across all settings Human Health Because AMR reduces the effectiveness of the antimicrobial treatment thereby prolonging patient illnesses and increasing the risk of spreading resistant microorganisms to others, establishing Infection Prevention and Control (IPC) interventions in healthcare settings iscrucial.IPC practices and guidelines not only ensure containment of infection and minimization of the occurrences of outbreaks, but also enable the reduction of diseases that require further use of antimicrobials. Ultimately, patient outcomes improve and overall treatment costs are reduced. IPC practices include basic hand hygiene, aseptic practices, environmental and waste management and the proper placement of patients with known or suspected diseases in their respective emergency, inpatient, ambulatory, medical, surgical or outpatient settings. Drug resistance does not only occur in the healthcare settings, but also at the household level. IPC, with proper training of health personnel and education in the community level, is therefore needed to combat AMR. Responsible Objectives Activities Timeline Measurement Budget (PhP) Agency To improve the Development of 2015 Approval and DOH (HPCS, None capacities of the National Policy implementation PD), DILG health on IPC of a National personnel and Policy on IPC community Conduct of 2016 DOH (HFDB, DOH (HFDB) 2,000,000 activities on IPC HPCS, PD), promotion and DILG education in the community level Conduct of 2016 Training DOH (PD, None training for manuals; HFDB) hospital number of personnel on hospital IPC personnel implementation trained To implement Strengthen 2015 onwards IPC Monitoring DOH (HFDB None programs on implementation reports from all and HFSRB) IPC of IPC hospitals measures in hospitals Animal Health It has been found by the European Food Safety Authority (EFSA) that some resistant strains found in human diseases, such as Campylobacter and Salmonella bacteria, actually originate from farm animals. Philippine Action Plan to Combat AMR: One Health Approach 35 Increasing the implementation and instilling standard practices in the agricultural sector enables a broader and faster application of strategies to not only combat AMR, but also to minimize its development and impacts. Responsible Objectives Activities Timeline Measurement Budget (PhP) Agency To implement Implementation of 2015 onwards Training sessions DA (BAI, 10,000,000.00 programs on Good Animal conducted; number BFAR) IPC Husbandry of farms registered Practices (GAHP) with GAHP and and Good GAqP; Validation of Aquaculture codes of good Practices (GAqP) practice (audits and as Philippine renewal) National Standards Strengthen animal 2015 onwards Workshops health system conducted/info capacity materials disseminated on the implementation of relevant policies on proper use of antimicrobials Key Strategy 06:Foster innovation, research, and development Human Health The problem of AMR causing the deterioration of the effectiveness of antimicrobials is coupled with the shrinking pipeline of new antimicrobials. With the decline of antibiotic discovery for the last decade, the WHO has emphasized that we are in race against time to develop new antibiotics. While there are several option interventions to prevent the emergence and spread of resistant infections, AMR as a natural phenomenon is inevitable; thus, new medicines and other tools to control infections will still be needed in the future. As the trend of AMR continue to rise, so should the effort in developing new health technologies escalate as well. Developing rapid diagnostic tests are important as well to better guide physicians on prescribing the appropriate antimicrobial treatment for the patients. Responsible Objectives Activities Timeline Measurement Budget (PhP) Agency To prioritize Inclusion of 2015 Mention of AMR DOST None AMR in fields of AMR detection, in NUHRA and research prevention and e-health control in the development National Unified plan Health Research Agenda (NUHRA) and unified IT program on AMR to the eHealth Development Plan Philippine Action Plan to Combat AMR: One Health Approach 36 Engaging 2016 MOA/MOU, ICAMR academic and research other research contracts; institutions technical reports and products Develop AMR 2015 AMR Research DOH 23,000,000.00 research Agenda Agenda for human health Provide 2016 Funded DOH and DOST incentive and research research projects funding for innovators To disseminate Inventory of 2015 Database on ICAMR 3,000,000.00 scientific AMR-related local researches information researches on relevant to AMR humans Animal Health The causes, effects and impacts of AMR in the animal sector entail a better and deeper knowledge of the phenomena’s complexity. Veterinary antimicrobial consumption needs be further assessed in order to determine the correlation of AMR in both animal and human health in the country. Moreover, toxicological studies need to be performed to establish the safety of veterinary drug residues in the human diet, as well in the human intestinal flora. Researches are needed to enhance the development of effective strategies and alternatives to combat AMR in food-producing animals. Responsible Objectives Activities Timeline Measurement Budget (PhP) Agency To prioritize Inclusion of AMR 2015 Mention of AMR DOST None AMR in fields detection, prevention in NUHRA and e- of research and control in the health National Unified Health development Research Agenda plan (NUHRA) and unified IT program on AMR to the eHealth Development Plan Engaging academic and 2016 MOA/MOU, ICAMR other research research institutions contracts; technical reports and products Develop AMR research 2015 AMR Research DA (PCC) 5,000,000.00 Agenda for animal Agenda health To Inventory of AMR- 2015 Database on ICAMR 3,000,000.00 disseminate related researches on local researches scientific animals information Upgrade existing IT 2016 Upgraded IT ICAMR relevant to system system AMR Philippine Action Plan to Combat AMR: One Health Approach 37 Key Strategy 07:Development of a Risk Communication Plan to combat AMR Human Health The success and sustainability of all actions and commitments by various stakeholders in overcoming AMR necessitates good and effective communication in all levels from planning, implementation, monitoring and evaluation. A risk communication plan not only signifies infection control measures. It is also being able to provide relevant scientific information that is accessible to all and is effectively understood by all relevant stakeholders with strong emphasis on the role of every Filipino in the overall cause-and-effect picture of the AMR problem. Responsible Objectives Activities Timeline Measurement Budget (PhP) Agency To develop a Development of 2015 onwards Risk DOH (PD and 3,500,000.00 targeted risk a risk Communication HPCS) communication communication Plan and IEC plan for AMR plan and IEC materials materials Production and 2014-2016 IEC materials DOH (PD and distribution of HPCS) IEC materials Conduct of 2015-2016 Minutes of the ICAMR advocacy meeting meetings with stakeholders (targeted) Development of 2015 AO on AMR DOH (PD) AO for the AMR Awareness Awareness Month issued Month Animal Health The development of standard treatment guidelines must be in line with proper training and education of farmers and veterinarians in the industry. The improvement of animal health constitutes that the professionals working in the sector are well-informed of the risks of their actions, and that information on antibiotics, AMR and animal health are well-disseminated. This tool is important in assessing the risks of AMR in animal health, and in determining the appropriate strategies to mitigate these challenges. Responsible Objectives Activities Timeline Measurement Budget (PhP) Agency To develop a Launch of AMR pledge 2014 Number of DA 5,000,000.00 targeted risk in veterinary sector Pledges communication for AMR Conduct of KAP study 2015 Technical reports DA for the farmers, onwards stakeholders on prudent antimicrobial use/ impact of uncontrolled use of antimicrobials Development of risk 2015 Risk DA (NMIS) communication plan onwards Communication specifically anchored to Plan and IEC Good Veterinary materials Philippine Action Plan to Combat AMR: One Health Approach 38 Practices targeting veterinarians and IEC plan Production and 2015 IEC materials DA distribution of IEC onwards materials Conduct of advocacy 2015 Minutes of the DA meetings with onwards meeting stakeholders Philippine Action Plan to Combat AMR: One Health Approach 39 REFERENCES: Antimicrobial Resistance Surveillance Reference Laboratory, Antimicrobial Resistance Surveillance Program 2013 Annual Report. Available from: Department of Health. [2014]. Antimicrobial Resistance Surveillance Reference Laboratory, Antimicrobial Resistance Surveillance Program 2014 Annual Report. Available from: Department of Health. [2015]. Department of Health 2011, Leading Causes of Mortality.Available from: <http://www.doh.gov.ph/node/198.html>. [10 June 2015]. Department of Health 2011, Leading Causes of Morbidity. Available from: <http://www.doh.gov.ph/kp/statistics/morbidity.html>. [10 June 2015]. O’ Neill, 2014, Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations. Available from: <http://amr-review.org/sites/default/files/AMR%20Review%20Paper%20- %20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf>. [7 July 2015] Republic of the Philippines 2014, Administrative Order No. 42: Creating an Inter-Agency Committee for the Formulation and Implementation of a National Plan to Combat Antimicrobial Resistance in the Philippines. Available from: <http://www.gov.ph/downloads/2014/04apr/20140410-AO-0042-BSA.pdf>. [7 July 2015]. World Health Organization, 2011, Policy Package to Combat Antimicrobial Resistance.Available from: <http://www.who.int/world-health-day/2011/presskit/WHDIntrototobriefs.pdf?ua=1>. [9 June 2015] World Health Organization, 2014, Antimicrobial Resistance Global Report on Surveillance. Available from: <http://apps.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf>. [9 June 2015] World Health Organization, 2015, Action Agenda for Antimicrobial Resistance in the Western Pacific Region, WHO Press: World Health Organization 20, Avenue Appia - 1211 Geneva 27, Switzerland Philippine Action Plan to Combat AMR: One Health Approach 40